Method and system for detecting arterial blood pressure dumping and performing automatic rapid flushing of catheter tubing - Patents.com

Abstract

Systems, devices, and methods are provided for determining whether an arterial blood pressure signal damping event is occurring and automatically flushing the catheter tubing in response to determining that an arterial blood pressure signal damping event is occurring. In one example, the determination of whether an arterial blood pressure signal damping event is occurring is based on a distinctive pattern change in the arterial blood pressure signal that exceeds one or more specified threshold values ​​within a specified time window. Additionally or alternatively, a determination as to whether the arterial blood pressure signal damping event has resolved is made in response to automatically flushing the catheter tubing based on the arterial blood pressure signal.

Description

[Technical field]

[0001] The following relates generally to the medical, medical monitoring, physiological monitoring, patient safety, and related arts. More particularly, embodiments herein relate to the use of automatic flushing to maintain a stable arterial blood pressure (ABP) signal for patient monitoring. [Background technology]

[0002] Invasive arterial (intra-arterial) blood pressure (IABP) monitoring is a technique commonly used in intensive care units (ICUs). Such arterial blood pressure (ABP) monitoring is also often used in operating rooms, for example, when hemodynamic instability is a risk or when beat-to-beat measurements and visualization of the pressure waveform are useful.

[0003]

[0003] In current clinical practice, ABP signals are typically measured using an arterial catheter and an external pressure sensor. For example, ABP monitoring typically involves the insertion of a catheter into a suitable artery (such as the radial artery) that is connected to a tubing system, but which is also operatively associated with an external pressure sensor.

[0004]

[0004] Such ABP signals may deteriorate over time. For example, the ABP signal may deteriorate over time due to blood clot formation and / or other factors. Such deterioration of the ABP signal may potentially impede / attenuate the transmission of pressure from the artery to the external pressure sensor. Thus, such deterioration of the ABP signal may result in erroneous ABP measurements, leading to false ABP alarms and / or misinterpretation of the patient's hemodynamic status.

[0005]

[0005] As discussed above, such ABP dumping is an abnormal measurement condition in invasive ABP monitoring. Such ABP dumping needs to be identified and fixed in a timely manner to avoid leading to a wrong interpretation of the patient's hemodynamic state and / or generating a false alarm. Since such ABP dumping conditions are typically observed / identified manually, such ABP dumping conditions may be overlooked or erroneously identified due to human error and / or fatigue-related delays.

[0006]

[0006] Furthermore, flushing operations in response to ABP dumping situations have also typically been performed manually, thus adversely affecting associated clinical workflow and increasing clinical workload.

[0007]

[0007] The following discloses certain improvements to overcome these and other problems. Summary of the Invention [Problem to be solved by the invention]

[0008]

[0008] As discussed above, arterial blood pressure dumping identification and fast flushing operations are typically performed manually in current clinical practice. Advantageously, some embodiments described herein present methods and systems for automatic detection of arterial blood pressure dumping and automatic flushing accordingly. [Means for solving the problem]

[0009]

[0009] As will be discussed in more detail below, the embodiments described herein provide a method and system for detecting an arterial blood pressure signal damping event and automatically flushing the catheter tube accordingly. Additionally or alternatively, some implementations herein evaluate the effectiveness of the automatic flushing and send a notification when the damped arterial blood pressure signal is not resolved after the automatic flushing. Moreover, some implementations herein evaluate the effectiveness of the automatic flushing and initiate another iteration of the automatic flushing and track (e.g., reassess) the effectiveness of further flushing. In such an example, if N (e.g., N is defined by a user, etc.) automatic flushings are not effective, a notification will be sent with an alarm message.

[0010]

[0010] In some implementations herein, a method and system are provided for determining whether an arterial blood pressure signal dumping event has occurred and automatically flushing a catheter tube in response to the determination that an arterial blood pressure signal dumping event has occurred. In one example, the determination of whether an arterial blood pressure signal dumping event has occurred is based on a characteristic pattern change of the arterial blood pressure signal within a specified time window and exceeding one or more specified threshold values. Additionally or alternatively, the determination of whether the arterial blood pressure signal dumping event has resolved is made in response to the automatic flushing of the catheter tube based on the arterial blood pressure signal.

[0011] In one aspect, an arterial blood pressure management system includes a pressure sensor receptor and an arterial blood pressure monitor communicatively coupled to the pressure sensor input. The pressure sensor receptor receives an arterial blood pressure signal detected by the pressure sensor. The arterial blood pressure monitor determines whether an arterial blood pressure signal damping event has occurred based on the arterial blood pressure signal. The arterial blood pressure monitor transmits a command to an electronically controllable (e.g., automatic) valve to automatically flush the catheter tubing in response to determining that an arterial blood pressure signal damping event has occurred. The arterial blood pressure monitor determines whether the arterial blood pressure signal damping event has been resolved in response to the automatic flushing of the catheter tubing based on the arterial blood pressure signal. In such an example, the determination that an arterial blood pressure signal damping event has occurred is based on a first criterion and the determination that the arterial blood pressure signal damping event has been resolved is based on a second criterion different from the first criterion.

[0012]

[0012] In one example, the determination of whether an arterial blood pressure signal damping event has been resolved in response to an automatic flush of the catheter tube is based on a change between one or more arterial blood pressure characteristics acquired within a specified time window before the automatic flush and one or more arterial blood pressure characteristics acquired within a specified time window after the automatic flush that exceeds a specified threshold value. For example, the determination of whether an arterial blood pressure signal damping event has occurred is based on determining whether there is a beat-to-beat continuous decrease in the systolic arterial blood pressure based on a first threshold value of the one or more specified threshold values. Additionally or alternatively, the determination of whether an arterial blood pressure signal damping event has occurred is based on determining whether there is a beat-to-beat continuous decrease in the difference between the systolic arterial blood pressure and the diastolic arterial blood pressure based on a second threshold value of the one or more specified threshold values. Additionally or alternatively, the determination of whether an arterial blood pressure signal damping event has occurred is based on determining whether the mean arterial blood pressure is stable over time based on a third threshold value of the one or more specified threshold values. Additionally or alternatively, determining whether an arterial blood pressure signal dumping event has occurred is based on determining whether the diastolic arterial blood pressure is stable over time based on a fourth threshold value of the one or more specified threshold values. Additionally or alternatively, determining whether an arterial blood pressure signal dumping event has occurred is based on determining whether a percentage of pulses having a signal quality that exceeds the signal quality threshold value, within a specified time window, exceeds a fifth threshold value of the one or more specified threshold values.

[0013] In another aspect, the method includes determining whether an arterial blood pressure signal damping event has occurred based on a decrease in the arterial blood pressure signal within a specified time window and exceeding one or more specified threshold values. The method further includes automatically flushing the catheter tubing in response to determining that an arterial blood pressure signal damping event has occurred.

[0014] In yet another aspect, the machine readable storage includes machine readable instructions that, when executed, include operations for determining whether an arterial blood pressure signal damping event is occurring based on a distinctive pattern change in the arterial blood pressure signal within a specified time window and exceeding one or more specified threshold values. The machine readable instructions further include operations, when executed, for automatically flushing the catheter tubing in response to determining that an arterial blood pressure signal damping event is occurring.

[0015] In yet another aspect, the apparatus includes means for determining whether an arterial blood pressure signal damping event is occurring based on a distinctive pattern change in the arterial blood pressure signal within a specified time window and exceeding one or more specified threshold values. The apparatus further includes means for automatically flushing the catheter tubing in response to determining that an arterial blood pressure signal damping event is occurring.

[0016]

[0016] It should be understood that all combinations of the above concepts and additional concepts discussed in more detail below (provided that such concepts are not mutually inconsistent) are contemplated as part of the subject matter disclosed herein. In particular, all combinations of claimed subject matter appearing at the end of this disclosure are contemplated as part of the subject matter disclosed herein. Furthermore, it should be understood that the terminology explicitly used in this specification that appears in any disclosure incorporated by reference should be given the intent that is most consistent with the specific concepts disclosed herein.

[0017]

[0017] These and other aspects of the various embodiments will be apparent from and elucidated with reference to the embodiment(s) described hereinafter.

[0018]

[0018] Various advantages of the embodiments will become apparent to those skilled in the art upon reading the following specification and appended claims, and upon review of the following drawings. [Brief description of the drawings]

[0019] [Figure 1] FIG. 1 illustrates a block diagram of an exemplary arterial blood pressure monitor. [Diagram 2]

[0020] FIG. 1 illustrates a graph of an arterial blood pressure signal having an arterial blood pressure damping event. [Diagram 3]

[0021] FIG. 1 illustrates a block diagram of an exemplary arterial blood pressure management system, according to an embodiment. [Figure 4]

[0022] FIG. 1 illustrates a flowchart of an exemplary method of operating an arterial blood pressure management system, according to an embodiment. [Diagram 5]

[0023] 10 is a further diagram illustrating a flowchart of an exemplary method of operating an arterial blood pressure management system, according to an embodiment. [Figure 6]

[0024] FIG. 13 illustrates a graph of an example detection of an arterial blood pressure dumping event and the resulting assessment of recovery for the dumping event after a corresponding flush, according to an embodiment. [Figure 7]

[0025] 13A-13F further illustrate graphs of an exemplary detection of an arterial blood pressure dumping event and the resulting assessment of recovery of the dumping event after corresponding repeated flushes, according to an embodiment. [Figure 8]

[0026] FIG. 1 illustrates a block diagram of a computer program product according to an embodiment. [Figure 9]

[0027] FIG. 2 further illustrates an EMR management system, according to an embodiment. [Figure 10]

[0028] FIG. 2 illustrates a hardware device including a semiconductor package, according to an embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0020]

[0029] As described in more detail below, in some implementations discussed herein, once an ABP dumping condition is detected, a control signal is issued to initiate an automatic fast flushing operation. The ABP signal continues to be analyzed immediately after the automatic flushing and evaluated to determine whether the attenuated ABP signal has been resolved (e.g., returned to normal). If the attenuated ABP signal has been resolved after the automatic flushing, the IABP monitoring process continues. If the attenuated ABP signal has not been resolved, the algorithm takes another automatic flushing action and evaluates the effectiveness of the flushing again. The automatic flushing and evaluation are attempted N times (e.g., where N is a selectable number, e.g., N=3). If after N automatic flushing fails, the algorithm issues an alarm / alert to the clinician regarding the ABP dumping. It should be noted that in addition to the automatic flushing action, a manual flushing operation is also available so that the clinician may perform further manual flushing if he / she deems necessary.

[0021]

[0030] In operation, some of the techniques described herein advantageously reduce the clinician's burden of manually observing and identifying ABP dumping conditions. Additionally or alternatively, some of the techniques described herein advantageously detect ABP dumping conditions in a timely manner to avoid flushing delays. Furthermore, some of the techniques described herein advantageously reduce false ABP alarms caused by ABP dumping. Additionally, some of the techniques described herein advantageously reduce the clinician's burden of manually flushing the tubing, thereby improving the associated clinical workflow. Finally, if some of the techniques described herein detect a false ABP dumping event (e.g., a false positive) and an automatic flush is erroneously performed, the adverse effects are limited because the automatic flush occurs in a very short period of time (e.g., 2-3 seconds), so the interruption of IABP monitoring should be very minor.

[0022]

[0031] 1 shows an illustration of a block diagram of an exemplary arterial blood pressure monitor 100. In the illustrated example, the arterial blood pressure monitor 100 includes a pressure bag 102 (e.g., containing pressurized saline), a flush tube 104, a stopcock 106, a catheter tube (e.g., pressure tube) 108, an intra-arterial cannula 110, a pressure sensor (e.g., pressure transducer) 112, a pressure sensor receptor (e.g., pressure cable) 114, and a pressure signal processing / display unit (monitor) 116 associated with a patient 111. Arterial blood pressure (ABP) is transmitted from the artery through a column of incompressible bubble-free fluid (e.g., 0.9% saline) in the catheter tube 108 to the pressure sensor 112. The flush tube 104 is connected to the pressure bag 102 (e.g., containing pressurized saline), typically pressurized to 300 mmHg, and attached to the catheter tube 108 via a flush system (e.g., stopcock 106). The flush system allows for a high pressure flush of fluid to keep the catheter tube 108 clean as well as to ascertain the dynamic characteristics of the system (eg, damping and natural frequency).

[0023]

[0032] In operation, with the required initial settings of the tubing system, invasive blood pressure (IABP) monitoring is performed continuously for several hours or even days. During such continuous monitoring, when a blood clot forms at the tip of the catheter, it can dampen the dynamic nature of the pressure transmitted to the sensor, resulting in a dampened pressure signal. There are several other factors that can cause ABP damping problems: there may be air bubbles in the tubing, the tubing may be kinked, the catheter may be moved to a location where fluid movement is hindered, or blood may be moving into the catheter. A dampened ABP signal can cause erroneous blood pressure (BP) measurements (e.g., especially systolic and diastolic BP), leading to false ABP alarms and / or causing misinterpretation of the hemodynamic status.

[0024]

[0033] Clinicians operating IABP monitoring should be alert for ABP dumping conditions, usually by observing the ABP waveform. When there is suspected ABP dumping, clinicians often need to take action with a fast flush to clear the tubing (which may be blocked by a blood clot, for example), allowing pressurized saline to advance through the catheter tubing for a short period of time (e.g., 2-3 seconds). If the dampened ABP signal resolves (e.g., returns to normal dynamic state) after the fast flush, IABP monitoring should continue, otherwise, further fast flushes should be performed. If multiple fast flushes do not resolve the dampened ABP signal, a new set of complete settings of the IABP tubing system is required.

[0025]

[0034] FIG. 2 shows a diagram of a graph 200 of an arterial blood pressure signal having an arterial blood pressure dumping event. FIG. 2 shows an actual case where a dampened ABP episode was identified and a fast flush was administered. After the flush, the ABP was restored. In the illustrated example, the ABP signal 202 is shown as dampened ABP 204. A flush 206 is shown to be performed (e.g., a manual flush by a care provider), resulting in a restored ABP 208.

[0026]

[0035] 3 shows a block diagram of an example arterial blood pressure management system 300, according to an embodiment. In the illustrated example, the arterial blood pressure management system 300 may be centralized or distributed and may include some or all elements and components of one or more computers or computer systems. For example, the arterial blood pressure management system 300 may include one server computer or multiple server computers (e.g., interconnected to form a server cluster, cloud computing resources, etc., and / or combinations thereof).

[0027]

[0036] In some implementations, the arterial blood pressure management system 300 is utilized as a control point element of an integrated clinical environment (ICE). As used herein, "integrated clinical environment (ICE)" refers to a platform for creating an Internet of Medical Things (IoT) associated with patient care. In such implementations, the arterial blood pressure management system 300 supports many real-time clinical decision support algorithms and closed-loop control algorithms of medical devices in the ICE.

[0028]

[0037] In the illustrated implementation, the arterial blood pressure management system 300 includes a pressure sensor receptor 114 and an arterial blood pressure monitor 302 communicatively coupled to a pressure sensor input of the pressure sensor receptor 114. The pressure sensor receptor 114 receives an arterial blood pressure signal detected by the pressure sensor 112.

[0029]

[0038] In the illustrated implementation, the arterial blood pressure management monitor 302 includes a processing module 304, a flushing algorithm 306, and a display 310 (e.g., presenting an alarm 312). For example, the processing module 304 amplifies, digitizes, filters, and scales the arterial blood pressure signal received from the pressure sensor 112 via the pressure sensor receptor 114, and the processing module 304 further performs pulse detection and feature extraction, and provides the scaled arterial blood pressure signal to other connected / coupled components. For example, the arterial blood pressure management monitor 302 is implemented as an invasive blood pressure (IABP) monitor.

[0030]

[0039] As discussed in more detail below, the flushing algorithm 306 triggers an alarm and / or an automatic flush in response to the arterial blood pressure signal from the processing module 304. For example, the flushing algorithm 306 performs ABP dumping detection by analyzing ABP waveform features in real time. In some implementations, the flushing algorithm 306 detects ABP pulses, evaluates the signal quality of the ABP pulses, extracts ABP pulse features, detects ABP dumping events by recognizing ABP dumping feature patterns, and / or combinations thereof. As discussed in more detail below, the automatic flushing device includes a computer-controlled electrical fluid value in the flush tube. Upon receiving a triggering signal from the ABP dumping detection flushing algorithm 306, the automatic flushing device performs a timed (e.g., in terms of time and duration) fast flush. Additionally or alternatively, the flushing algorithm 306 detects ABP recovery by tracking the ABP signal immediately after the automatic flush and determining whether the damped ABP signal has resolved. The return of the ABP signal to an undamped state has discernible characteristics (eg, systolic and pulse BP values ​​are significantly widened, maximum ABP waveform slope is significantly increased, etc.).

[0031]

[0040] In the illustrated implementation, the arterial blood pressure monitor 302 determines whether an arterial blood pressure signal damping event has occurred based on the arterial blood pressure signal. The arterial blood pressure monitor 302 transmits a command to the automatic valve 106 (e.g., an electronically controllable valve, such as a computer-controlled electrohydraulic valve) to automatically flush the catheter tubing 108 in response to determining that an arterial blood pressure signal damping event has occurred. The arterial blood pressure monitor 302 determines whether the arterial blood pressure signal damping event has been resolved in response to the automatic flushing of the catheter tubing 108 based on the arterial blood pressure signal. In such an example, the determination that an arterial blood pressure signal damping event has occurred is based on a first criterion and the determination that the arterial blood pressure signal damping event has been resolved is based on a second criterion that is different from the first criterion.

[0032]

[0041] In operation, the arterial blood pressure monitor 302 determines whether an arterial blood pressure signal damping event has occurred for a first criterion based on a distinctive pattern change in the arterial blood pressure signal within a specified time window and exceeding one or more specified threshold values. Additionally or alternatively, the arterial blood pressure monitor 302 determines whether an arterial blood pressure signal generated before a specified pre-flash time window exceeds one or more specified flash efficacy threshold values ​​for a second criterion compared to an arterial blood pressure signal generated after a specified post-flash time window. For example, the one or more specified flash efficacy threshold values ​​include a systolic arterial blood pressure threshold value, a pulse arterial blood pressure threshold value, an arterial blood pressure waveform slope threshold value, or the like, and / or combinations thereof.

[0033]

[0042] In the illustrated example, the arterial blood pressure management system 300 further includes a pressure sensor 112 for sensing the patient's arterial blood pressure and generating a signal, and an automatic valve 106 for automatically flushing the catheter tube 108. In some implementations, the pressure sensor input 114 is implemented as a cable or wireless communication device communicatively coupled to the pressure sensor 112. In some examples, the automatic valve 106 is an electronically controllable fluid valve installed in the flush tube that replaces or is used in addition to a manual valve.

[0034]

[0043] Additionally or alternatively, the arterial blood pressure management system 300 further includes a therapy device 320, a medical management device 322, a database 324 (e.g., an EMR database), a user interface 326 (e.g., one or more user interfaces 326 associated with a user), etc. (e.g., a patient monitor), and / or combinations thereof. For example, the therapy device 320, the medical management device 322, the database 324, and / or the user interface 326 communicate with each other via internet-based communications, cloud-based communications, wired communications, wireless communications, etc., and / or combinations thereof.

[0035]

[0044] In examples, a patient monitor (not shown) is configured to monitor the patient for vital signs, etc., and the patient monitor transmits such measured patient data to database 324. In some implementations, such patient monitors include bedside type monitors, transport type monitors, central station type monitors, etc., and / or combinations thereof.

[0036]

[0045] In another example, the therapy device 320 is configured to monitor the delivery of a particular therapy (e.g., a non-medicated treatment) to the patient and transmits such measured patient data to the database 324. In some implementations, the therapy device 320 is coupled to an arterial blood pressure monitor 302. For example, the therapy device 320 is a ventilator coupled to the arterial blood pressure monitor 302 as a closed-loop control system.

[0037]

[0046] In a further example, the medical management device 322 is configured to monitor drug delivery to the patient and transmits such measured patient data to the database 324. In some implementations, the medical management device 322 is coupled to the arterial blood pressure monitor 302. For example, the medical management device 322 is a vasoactive drug delivery pump coupled to the arterial blood pressure monitor 302 as a closed-loop control system.

[0038]

[0047] Additionally or alternatively, in further examples, the user interface 326 is implemented by one or more form factor devices (e.g., a smartphone, tablet, laptop, workstation, and / or the like), an interface associated with the arterial blood pressure monitor 302, and / or an interface associated with a patient monitor. Additionally or alternatively, the care provider receives patient data through analog devices, non-networked patient monitors, non-networked therapy devices, non-networked medical management devices, etc., and / or combinations thereof.

[0039]

[0048] In the illustrated implementation, the database 324 includes one or more types of patient data. For example, the database 324 includes patient data including lab result data, microbiology data, medication data, vital signs data, treatment order data, admission, discharge and transfer data, and / or the like. As used herein, the term "database" refers to a collection of data and information organized to allow the data and information to be stored, retrieved, updated, and / or manipulated. As used herein, the term "database" also refers to a database that is locally present or accessed from a remote location (e.g., via a remote network server).

[0040]

[0049] The term "patient data" as used herein refers to data or information that identifies an individual. Patient data includes patient data measured from analog medical devices, sensors, patient monitors, therapeutic devices, medical management devices, medical imaging devices, and / or combinations thereof. Additionally, patient data includes patient name, age, weight, previous medical history, hospital admission number, changes in medical personnel, admission dates, medical conditions, medical status, and / or combinations thereof.

[0041]

[0050] Additionally or alternatively, in some implementations, the database 324 includes or is associated with a simulated database. In such examples, such a simulated database generates estimated patient data. For example, the simulated database utilizes some measured patient data to generate some other estimated patient data. Such a simulated database may utilize, for example, digital twin techniques to make the estimation. In such examples, such estimated patient data is marked to indicate its estimated nature (rather than the measured patient data). Additionally or alternatively, a weight factor is applied to the estimated patient data such that the estimated patient data has a lower weight than the corresponding measured patient data.

[0042]

[0051] As used herein, the term "closed loop control system" refers to a system that relies on feedback to make ongoing automatic adjustments without input from a user. For example, a user establishes parameters for a given system (e.g., establishing one or more set points, ranges of acceptable operation, thresholds, etc., and / or combinations thereof) while such a closed loop control system utilizes blood pressure feedback from an arterial blood pressure monitor 302 to make automatic adjustments to a given therapy, drug delivery, etc., and / or combinations thereof.

[0043]

[0052] In some implementations, the procedures described herein are performed via one or more of a server, a smart hub, a smart cable, an arterial blood pressure monitor 302, a therapy device 320, a medical management device 322, and / or combinations thereof.

[0044]

[0053] As used herein, the term "smart hub" refers to software, firmware, and / or hardware adapted to monitor and / or control a plurality of Internet of Things (IoT) devices. Additionally or alternatively, such a smart hub will monitor and / or control interactions between individual devices among the plurality of Internet of Things (IoT) devices.

[0045]

[0054] As used herein, the term "smart cable" refers to a power cable and / or a communications cable that includes software, firmware and / or hardware adapted to monitor and / or control one or more devices communicatively coupled to such smart cable.

[0046]

[0055] ABP pulse detection and feature extraction

[0047]

[0056] In operation, the ABP pulse detection and feature extraction techniques described herein perform several tasks related to analyzing ABP signals, namely, pulse detection, pulse feature extraction, signal quality assessment, etc., and / or combinations thereof.

[0048]

[0057] For pulse detection, a gradient sum function based heart beat pulse detection algorithm is utilized, which reliably detects the ABP pulse by its onset.

[0049]

[0058] For pulse feature extraction, a group of ABP pulse features such as pulse interval between beats, instantaneous ABP value, and short-term averaged ABP value with signal quality control (e.g., including systolic, diastolic, mean, and pulse pressure), instantaneous maximum ABP slope, and short-term averaged maximum ABP slope with signal quality control (e.g., including positive and negative) are extracted for each beat and associated with each pulse.

[0050]

[0059] For signal quality assessment, the ABP signal quality is assessed for each detected pulse by analyzing various ABP waveform features, and a signal quality index (SQI) value ranging from 0 to 1 (e.g., 1 indicates best quality and 0 indicates poorest quality) is determined and associated with the pulse.

[0051]

[0060] Detection of ABP damping events

[0052]

[0061] In operation, the ABP dumping detection technique described herein detects ABP dumping events by using the following features / characteristics of the detected ABP waveform:

[0062] 1) Systolic ABP decreases slowly from pulse to pulse.

[0063] 2) Pulse ABP (i.e., the difference between systolic and diastolic BP) decreases slowly from pulse to pulse, reaching a significantly lower level (e.g., 65%).

[0064] 3) Mean ABP remains relatively stable, i.e., maintained at approximately the same level.

[0065] 4) Diastolic ABP remains relatively unchanged, i.e., maintained at approximately the same level.

[0066] 5) Most (e.g., 90%) of the ABP pulses have sufficient signal quality (e.g., SQI>0.9).

[0053]

[0067] The output of the ABP damping detection technique described herein is a flash necessity index (FNI) that has a binary value of 0 or 1, with 1 indicating that a flash is needed when the ABP waveform is dampened and 0 if the ABP waveform is not dampened.

[0054]

[0068] The specific design and implementation of the ABP damping detection algorithm is as follows: i ) for P i The time window before (T w Assume that there are N pulses detected within the T . The ABP features from those N pulses are examined and the following variables are defined and calculated: w is 2 minutes (120s).

[0055]

[0069] T w The percentage of pulses having good signal quality in

[0070] P good_SQI =M / N (1),

[0071] where N is the number of windows (T w ) and M is the number of pulses with good signal quality (T w (i.e., the SQI value is higher than a predefined threshold, e.g., SQI>0.7).

[0056]

[0072] T wThe percentage of pulses containing short-term averaged systolic BP (sBPa) that falls within

[0073] P sBPa_decline = K / N (2),

[0074] where K is the number of pulses whose sBPa is lower than the sBPa of the previous pulse (T w (within

[0057]

[0075] T w The percentage of pulses containing short-term averaged pulses BP (pBPa) falling within

[0076] P pBPa_decline = L / N; (3)

[0077] where L is the pulse whose pBPa is lower than the pBPa of the previous pulse (T w (within

[0058]

[0078] T w The difference in mean BP (mBPa) averaged over a short period of time was:

[0079] mBP i_vs_x = mBPa(i) / mBPa(x) (4),

[0080] Here, mBPa(i) is the mBPa value at the current pulse time (i), and mBPa(x) is the mBPa value at time x (x=iT w ) mBPa value.

[0059]

[0081] T w The difference in diastolic BP (dBPa) averaged over a short period of time was:

[0082] dBP i_vs_x = dBPa(i) / dBPa(x) (5),

[0083] Here, dBPa(i) is the dBPa value at the current pulse time (i), and dBPa(x) is the dBPa value at time x (x=iT w ) dBPa value.

[0060]

[0084] T w The difference in pulse BP (pBPa) averaged over a short period is

[0085] pBP i_vs_x = pBPa(i) / pBPa(x); (6)

[0086] Here, pBPa(i) is the pBPa value at the current pulse time (i), and pBPa(x) is the value at time x (x=iT w ) is the pBPa value.

[0061]

[0087] The ABP Flush Necessity Index (FNI) is derived from the following logic:

[0088] IF P good_SQI >thr1 AND

[0089] (P sBPa_decline >thr2 OR P pBPa_decline >thr3) AND

[0090] (mBP i_vs_x >thr4 OR dBP i_vs_x >thr5) AND

[0091] pBP i_vs_x <thr6

[0092] THEN FNI=1;

[0093] ELSE FNI=0; (7)

[0094] where thr1, thr2, thr3, thr4, thr5, and thr6 are suitable thresholds empirically obtained from experimental data. In this embodiment, thr1 is selected as 0.9, thr2 is selected as 0.6, thr3 is selected as 0.6, thr4 is selected as 0.85, thr5 is selected as 0.9, and thr6 is selected as 0.65.

[0062]

[0095] FNI is calculated on a heartbeat basis.

[0063]

[0096] As described in more detail below, FIG. 6 shows an example result of ABP dumping detection. As illustrated, the ABP Raw Signal 602 panel is an episode of ABP raw signal recorded from an ICU patient, in which there were two ABP dumping events, followed by a flush performed manually by an ICU nurse (e.g., the manual flush event may be understood as a pressure saturated pulse). The ABP SQI 604 panel shows the generated ABP signal quality index (SQI) value of the auto-flush technique described herein. The Systolic ABPa 606, Diastolic ABPa 608, and Pulse ABPa 610 panels show the generated short-term averaged (e.g., SQI controlled) systolic, diastolic, and pulse blood pressure values, respectively, of the auto-flush technique described herein. The ABP Damping (FNI) 612 panel is the FNI (Boolean) value generated by the ABP damping detection algorithm. Referring to the original upper end ABP signal, the ABP damping detection algorithm triggers before the manual flush event as desired, and the FNI signal remains true until the flush event. Thus, the example graph 600 illustrates that the auto-flush technique described herein can take action before a skilled ICU nurse.

[0064]

[0097] Alternatively or additionally, in response to determining that an arterial blood pressure signal dumping event is occurring, the arterial blood pressure monitor 302 automatically generates one or more of an audio, visual, or tactile warning signal to alert a medical clinician or professional to perform IABP monitoring. This warning of an arterial blood pressure signal dumping event is stored in a medical database system and used to prevent associated false positive blood pressure alarms.

[0065]

[0098] Alternatively or additionally, in response to determining that an arterial blood pressure signal dumping event is occurring, the arterial blood pressure monitor 302 automatically initiates a non-invasive arterial BP (NIABP) measurement of the subject S. The NIABP measurement does not have to be initiated in the event that one or more recent NIABP measurements of the subject S are available and stored in one or more of the databases 324.

[0066]

[0099] According to one or more exemplary embodiments, the arterial blood pressure management system 300 dynamically monitors the patient's ABP performance by looking for one or more identifiable patterns in the IABP waveform that are associated with damping. The Flash Effectiveness Assessment (FEA) technique described herein is applied to dynamically analyze the IABP waveform in real time to automatically detect one or more identifiable patterns.

[0067]

[0100] Start automatic flushing

[0068]

[0101] In operation, when an ABP dumping event is detected, a flushing control signal, such as a single pulse or a square wave, is issued to initiate the automatic flushing control. Thus, the automatic valve 106 is opened for an appropriate period of time (e.g., 2 seconds) and then closed to complete the automatic flushing operation control. The flushing control signal, such as a square wave, allows for multiple automatic flushing operations to be performed when such multiple automatic flushing operations are required.

[0069]

[0102] For example, when damping is detected, the arterial blood pressure monitor 302 sends a first control signal to automatically initiate a fast flushing sequence. The flush effectiveness assessment (FEA) technique described herein continues to analyze the IABP waveform after the fast flushing sequence to evaluate whether the detected damped IABP waveform has resolved (e.g., returned to normal). If the damped IABP waveform has resolved after the fast flushing sequence, the IABP monitoring process continues.

[0070]

[0103] According to one or more exemplary embodiments, the automatic fast flush sequence is performed by a flushing device that includes an automatic valve 106 (e.g., a computer-controlled electro-fluidic valve) in the flush tube 104. Upon receiving a triggering signal from the arterial blood pressure monitor 302, the arterial blood pressure management system 300 causes a timed (e.g., with respect to time and duration) fast flush to occur.

[0071]

[0104] ABP recovery detection (after flash)

[0072]

[0105] In operation, the arterial blood pressure monitor 302 is configured to track the ABP waveform immediately following the automatic flushing sequence and then determine whether the attenuated ABP waveform has been restored, e.g., whether the flushing maneuver is effective. ABP waveform restoration is indicated by one or more identifiable features, e.g., the systolic and pulse BP values ​​are significantly widened and the maximum ABP waveform slope is significantly increased.

[0073]

[0106] According to one or more embodiments, detection of ABP recovery by the arterial blood pressure monitor 302 after performance of an automatic flushing sequence is performed by the arterial blood pressure monitor 302 initiating a flush efficacy assessment (FEA) algorithm. The FEA algorithm tracks certain ABP waveform features immediately following the automatic flushing sequence and then compares them to the same features taken immediately prior to the automatic flushing sequence to determine whether the ABP waveform has recovered.

[0074]

[0107] The specific design and implementation of the FEA algorithm is as follows: The automatic flushing sequence start time is F on Assume that the following ABP features before the flash sequence are F on T before b1 (e.g. T at 2s) b2 It is calculated from the ABP pulse of duration (e.g. 10 s).

[0108] T b2 pre-flush sBPa, which is the systolic ABP averaged over the

[0109] T b2 pBPa before the flash, which is the pulse ABP averaged over the

[0110] T b2 mxSLPa before the flash, which is the maximum ABP waveform slope averaged over the entire time period, but with good signal quality (e.g., SQI>0.9); b2 In this embodiment, only the ABP pulse of T b2 is chosen as 10s, T b1 is chosen as 2s and the SQI threshold as 0.9.

[0075]

[0111] Automatic flushing sequence end time F off Assume that the following ABP features after a flash are F off T after e1 (e.g. T at 3s) e2 It is calculated from the ABP pulse of duration (e.g. 10 s).

[0112] T e2 post-flush sBPa, which is the systolic ABP averaged over the

[0113] T e2 pBPa after flash, which is the pulse ABP averaged over ;

[0114] T e2 mxSLPa after the flash, which is the maximum ABP waveform slope averaged over the entire time period, provided that the signal has good signal quality (e.g., SQI>0.9); e2 According to one or more exemplary embodiments, only the ABP pulse of T e2 is chosen as 10s, T e1 is chosen as 3s and the SQI threshold as 0.9.

[0076]

[0115] The Flash Effectiveness Index (FEI) is derived from the following logic:

[0116] FEI=0;

[0117] IF pABPa_after_flush / pABPa_before_flush >r1 AND

[0118] sABPa_after_flush / sABPa_before_flush >r2 AND

[0119] mxSLPa_after_flush / mxSLPa_before_flush >r3 AND

[0120] THEN FEI=1; (for 2s)

[0121] ELSE FEI=-1; (for 2s) (8),

[0122] where r1, r2, and r3 are suitable (ratio) thresholds empirically derived from experimental data. According to one or more exemplary embodiments, r1 is selected as 1.5, r2 is selected as 1.2, and r3 is selected as 2.0.

[0077]

[0123] The FEI value is initialized as 0. If the automatic flushing sequence is effective (i.e., ABP signal restored), the FEI receives a value of "1" (for 2s and then returns to a value of 0 to visually indicate the result). On the other hand, if the automatic flushing sequence is unsuccessful, the FEI receives a value of "-1" (for 2s and then returns to a value of 0 to visually indicate the result). off The time after (T e1 +T e2 ) is determined. This short delay is necessary because a reasonable period of time is required to reliably acquire the ABP characteristics after the automatic flashing sequence. The skip window T b1 and T e1 is introduced to eliminate ABP waveforms that are very close to (and therefore may be disturbed by) the auto-flushing sequence.

[0078]

[0124] The FEI is calculated immediately after the end of each automatic flushing sequence. Further details regarding the FEI results are described below with reference to Figures 6 and 7.

[0079]

[0125] To illustrate the FEI results, as will be described in more detail below in the illustrated example of FIG. 6, a flushing signal is generated according to a manual flushing operation on an ABP recording for a skilled ICU medical clinician or specialist, as described in the Flush Operation 614 panel of FIG. 6. The flushing signal includes a single pulse or square wave function, including its non-zero value, corresponding to the manual flushing operation for the medical clinician or specialist (e.g., as identified by the saturated ABP signal shown in the ABP Raw Signal 602 panel). The proposed FEA algorithm executed by the arterial blood pressure monitor 302 captures the start and stop times of each flushing operation and calculates the time (T) after the flush stop time for this flush, as shown in the Flush Effectiveness (FEI) 616 panel. e1 +T e2) to produce an FEI value. The FEI value lasts for a duration of 2 seconds and returns to zero to visually observe the results of the flash effectiveness evaluation. As seen on the Flash Effectiveness (FEI) 616 panel, both flashes are properly rated as effective.

[0080]

[0126] As described in more detail below in the illustrated example of FIG. 7, multiple flashes were performed for IABP dumping detection and flash effectiveness evaluation. For the first IABP dumping event, it is properly detected by the arterial blood pressure monitor 302, as shown by the FNI value in the ABP dumping (FNI) 712 panel, and further prior to visual observation by the medical clinician or expert. The flash sequence includes four manual flashes performed by the medical clinician or expert (as shown in the Flash Operation 714 panel). The first three flashes corresponded to the first dumping event. Of the first three flashes, the first two flashes were ineffective, and the third flash was successful (e.g., effective). The proposed FEA algorithm executed by the arterial blood pressure monitor 302 properly evaluated the flushing effectiveness by generating an FEI (as shown in the Flash Effectiveness (FEI) 716 panel) with a value of −1 for the first two flashes and a value of 1 for the third flash. The fourth flash corresponds to the second ABP dumping event. The second IABP dumping event is properly detected by the arterial blood pressure monitor 302 prior to manual identification by the medical clinician or specialist. The (fourth) manual flushing maneuver (at approximately 07:17:00) is properly assessed as valid (FEI has a value of 1).

[0081]

[0127] According to one or more exemplary embodiments, the arterial blood pressure management system 300 is configured to label a detected IABP data stream associated with an ABP dumping event as "suspicious," thereby preventing the generation of alarms based on false positive physiological alarms according to its logic.

[0082]

[0128] As discussed in more detail below with reference to FIG. 5, if the ABP waveform is restored after the automatic flushing sequence, IABP monitoring continues. In the event that the IABP is not restored, a subsequent automatic flushing sequence is performed. If the number of flushes in the sequence exceeds a predefined or predetermined number M (e.g., M=3) but the IABP waveform is still not restored, the arterial blood pressure management system 300 alerts a medical clinician or professional by triggering the generation of an alarm (e.g., an audio warning signal, a visual warning signal, a tactile notification signal, etc., and / or a combination thereof) indicating that the catheter tube 108 has an overdamping problem and requires manual intervention to resolve the damping issue.

[0083]

[0129] 4 illustrates an example method 400 for operating an arterial blood pressure management system, according to an embodiment. The method 400 is typically implemented within an arterial blood pressure management system, such as, for example, the arterial blood pressure management system 300 (FIG. 3) previously discussed.

[0084]

[0130] In an embodiment, method 400 (as well as method 500 (FIG. 5)) is implemented in logic instructions (e.g., software), configurable logic, fixed function hardware logic, or the like, or any combination thereof. While certain portions of the operation of EMR-management system 300 (FIG. 3) are illustrated in method 400 (as well as method 500 (FIG. 5)), other portions of the operation of EMR-management system 300 (FIG. 3) have been intentionally left omitted to simplify the description of the methods.

[0085]

[0131] The illustrated processing block 402 implements determining whether an arterial blood pressure signal damping event is occurring, for example, based on a distinctive pattern change in the arterial blood pressure signal within a specified time window and exceeding one or more specified threshold values.

[0086]

[0132] The illustrated process block 404 implements automatically flushing the catheter tubing, for example, in response to determining that an arterial blood pressure signal damping event is occurring.

[0087]

[0133] Additional and / or alternative operations for method 400 are described in detail below in the description of FIG.

[0088]

[0134] 5 is a flow chart of another example method 500 for operating an arterial blood pressure management system according to an embodiment. The method 500 is typically implemented within an arterial blood pressure management system, such as, for example, the arterial blood pressure management system 300 (FIG. 3) previously discussed.

[0089]

[0135] The illustrated processing block 504 provides pulse detection and feature extraction from the signal 502. For example, pulse detection is performed on the arterial blood pressure signal. Additionally, pulse features are extracted from the arterial blood pressure signal.

[0090]

[0136] In some implementations, signal quality is determined for each beat associated with each pulse, for example, pulse features are extracted for each beat associated with each pulse, where the pulse features include one or more of: a pulse interval between beats, an instantaneous arterial blood pressure value, an averaged arterial blood pressure value, an instantaneous maximum arterial blood pressure slope, an averaged maximum arterial blood pressure slope, and / or combinations thereof.

[0091]

[0137] The illustrated processing block 506 provides for detection of arterial blood pressure dumping. For example, such a determination of whether an arterial blood pressure signal dumping event is occurring may be further based on one or more of determining whether there is a beat-to-beat continuous decrease in the systolic arterial blood pressure based on a first threshold value of the one or more specified threshold values, determining whether there is a beat-to-beat continuous decrease in the difference between the systolic arterial blood pressure and the diastolic arterial blood pressure based on a second threshold value of the one or more specified threshold values, determining whether the mean arterial blood pressure is stable over time based on a third threshold value of the one or more specified threshold values, determining whether the diastolic arterial blood pressure is stable over time based on a fourth threshold value of the one or more specified threshold values, determining whether the percentage of pulses having a signal quality that exceeds a signal quality threshold value within a specified time window exceeds a fifth threshold value of the one or more specified threshold values, and / or combinations thereof.

[0092]

[0138] In some implementations, determining that an arterial blood pressure signal damping event has occurred is based on a first criterion, and determining that the arterial blood pressure signal damping event has been resolved is based on a second criterion that is different from the first criterion.

[0093]

[0139] Illustrated process block 508 provides a decision block as to whether the arterial blood pressure is dampened. In circumstances where it is determined that an arterial blood pressure signal damping event has not occurred, the method 500 returns to process block 504. In circumstances where it is determined that an arterial blood pressure signal damping event has occurred, the method 500 proceeds to process block 510.

[0094]

[0140] The illustrated process block 510 provides for triggering an optional alarm of an arterial blood pressure signal damping event.

[0095]

[0141] Additionally, the blood pressure limit alarm is inhibited in response to forwarding the damping event notification to the user interface.

[0096]

[0142] In the situation where the optional arterial blood pressure signal damping event alarm is triggered, the method 500 proceeds to process block 512; otherwise, the method 500 proceeds to process block 514.

[0097]

[0143] The illustrated process block 512 provides for delivering an optional alert of an arterial blood pressure signal damping event. For example, a notification of the damping event may be forwarded to a user interface 326 associated with a care provider and / or other device (e.g., the arterial blood pressure monitor 302, the therapy device 320, the medical management device 322, etc., and / or combinations thereof) in response to determining that an arterial blood pressure signal damping event is occurring.

[0098]

[0144] The illustrated process block 514 implements initializing a counter.

[0099]

[0145] The illustrated process block 516 provides for initiating an automatic flushing operation.

[0100]

[0146] The illustrated process block 517 realizes utilizing an electric flushing valve to perform the automatic flushing operation.

[0101]

[0147] The illustrated process block 518 provides for detection of arterial blood pressure recovery. For example, a determination as to whether an arterial blood pressure signal damping event has resolved is made in response to automatic flushing of the catheter tubing based on the arterial blood pressure signal. Such a determination that an arterial blood pressure signal damping event has resolved includes determining whether an arterial blood pressure signal that occurred before a specified pre-flash time window has exceeded one or more specified flush efficacy threshold values ​​compared to an arterial blood pressure signal that occurred after a specified post-flash time window.

[0102]

[0148] In some implementations, the one or more specified flash efficacy threshold values ​​include a systolic arterial blood pressure threshold value, a threshold value for the difference between the systolic arterial blood pressure and the diastolic arterial blood pressure (e.g., "pulsed ABP"), a threshold value for maximum arterial blood pressure waveform slope, and / or combinations thereof.

[0103]

[0149] Illustrated process block 520 provides a decision block as to whether arterial blood pressure recovery has occurred. In the situation where arterial blood pressure recovery has occurred, the method 500 returns to process block 504. In the situation where arterial blood pressure recovery has not occurred, the method 500 proceeds to process block 522.

[0104]

[0150] Illustrated process block 522 provides a decision block as to whether the counter has exceeded a preset maximum iteration value. In the situation where the counter has exceeded the preset maximum iteration value, the method 500 proceeds to process block 524. In the situation where the counter has not exceeded the preset maximum iteration value, the method 500 proceeds to process block 526.

[0105]

[0151] The illustrated processing block 524 provides for generating an alarm indicating that arterial blood pressure recovery has not occurred. For example, such an alarm may be generated after a limit of automatic flushes have been performed but have failed to resolve the arterial blood pressure damping. In some implementations, a pending flush notification is forwarded to a user interface 326 associated with a care provider and / or other device (e.g., arterial blood pressure monitor 302, therapy device 320, medical management device 322, etc., and / or combinations thereof) in response to determining that the arterial blood pressure signal damping event has not been resolved.

[0106]

[0152] Additionally, the blood pressure limit alarm is inhibited in response to forwarding of a pending flash notification to the user interface.

[0107]

[0153] The illustrated process block 526 implements incrementing the counter and returning to process block 516 .

[0108]

[0154] In operation, the method 500 is performed via one or more of a server, a smart hub, a smart cable, an arterial blood pressure monitor 302, a therapy device 320, a medical management device 322, etc., and / or combinations thereof.

[0109]

[0155] It will be understood that some or all of the operations in method 500 above that are described using a "pull" architecture (e.g., polling for new information followed by a corresponding response) may instead be implemented using a "push" architecture (e.g., sending new information when there is new information to report), and vice versa.

[0110]

[0156] 6 shows a graphical illustration 600 of an example detection of an arterial blood pressure dumping event and the resulting assessment of recovery for the dumping event after a corresponding flush, according to an embodiment. In the illustrated example, the ABP raw signal 602, the ABP SQI 604, the systolic ABPa 606, the diastolic ABPa 608, the pulse ABPa 610, the ABP dumping (FNI) 612, the flush maneuver 614 (e.g., a manual flush by a care provider), and the flush effectiveness (FEI) 616 are shown.

[0111]

[0157] Graph 600 shows an example of an ABP dumping event due to clot formation, along with the corresponding flush and return to normal pressure. The ABP dumping event is properly detected (e.g., earlier than a trained nurse would observe) by the techniques described herein (e.g., as shown by ABP dumping (FNI) 612). Both flushes are properly assessed as effective by the techniques described herein (e.g., as shown by flush effectiveness (FEI) 616).

[0112]

[0158] 7 shows a further diagram of a graph 700 of an example detection of an arterial blood pressure dumping event and the resulting assessment of recovery of the dumping event after corresponding repeated flushes, according to an embodiment. In the illustrated example, the ABP raw signal 702, the ABP SQI 704, the systolic ABPa 706, the diastolic ABPa 708, the pulse ABPa 710, the ABP dumping (FNI) 712, the flush maneuver 714 (e.g., a manual flush by the care provider), and the flush effectiveness (FEI) 716 are shown.

[0113]

[0159] Graph 700 shows another example of ABP dumping events due to clot formation along with the corresponding flushes. The two ABP dumping events are properly detected (e.g., earlier than the nurse's observation) by the techniques described herein (as shown by ABP dumping (FNI) 712). The effectiveness of the flushes (including effective and ineffective flushes) is properly assessed by the techniques described herein (as shown by flush effectiveness (FEI) 716).

[0114]

[0160] 8 illustrates a block diagram of an example computer program product 800. As shown in FIG. 8, in some examples, the computer program product 800 further includes a machine-readable storage 802 including logic 804. In some implementations, the machine-readable storage 802 is implemented as non-transitory machine-readable storage. In some implementations, the logic 804 is implemented as machine-readable instructions, such as, for example, software. In some embodiments, the logic 804, when executed, performs one or more aspects of the method 400 (FIG. 4), the method 500 (FIG. 5), and / or implements the arterial blood pressure management system 300 (FIG. 3), as previously discussed.

[0115]

[0161] 9 shows an illustrative example of an arterial blood pressure management system 300. In the illustrated example, the arterial blood pressure management system 300 includes a processor 902 and a memory 904 communicatively coupled to the processor 902. The memory 904 includes logic 906 as a set of instructions. In some implementations, the logic 906 is implemented as software. In an embodiment, the logic 906, when executed, performs one or more aspects of the method 400 (FIG. 4), the method 500 (FIG. 5), and / or implements the arterial blood pressure management system 300 (FIG. 3), as previously discussed.

[0116]

[0162] In some implementations, the processor 902 includes a general purpose controller, a special purpose controller, a storage controller, a storage manager, a memory controller, a microcontroller, a general purpose processor, a special purpose processor, a central processing unit (CPU), etc., and / or combinations thereof.

[0117]

[0163] Further, implementations include distributed processing, component / object distributed processing, parallel processing, etc., and / or combinations thereof. For example, a virtual computer system process may implement one or more of the methods or functions as described herein, and a processor 902 as described herein may be used to support such virtual processing.

[0118]

[0164] In some examples, memory 904 is an example of a computer-readable storage medium. For example, memory 904 is any memory accessible to processor 902, including, but not limited to, RAM memory, registers, register files, and / or combinations thereof. References to "computer memory" or "memory" should be interpreted as multiple memories, as the case may be. A memory may be, for example, multiple memories within the same computer system. A memory may also be multiple memories distributed among multiple computer systems or coding devices.

[0119]

[0165] 10 illustrates an exemplary semiconductor device 1000 (e.g., a chip and / or package). The illustrated device 1000 includes one or more substrates 1002 (e.g., silicon, sapphire, or gallium arsenide) and logic 1004 (e.g., configurable logic and / or fixed-function hardware logic) coupled to the substrate(s) 1002. In an embodiment, the logic 1004 performs one or more aspects of method 400 ( FIG. 4 ), method 500 ( FIG. 5 ), and / or implements the arterial blood pressure management system 300 ( FIG. 3 ), as previously discussed.

[0120]

[0166] In some implementations, logic 1004 includes transistor arrays and / or other integrated circuits / IC components. For example, configurable logic and / or fixed-function hardware logic implementations of logic 1004 include configurable logic such as, for example, a programmable logic array (PLA), a field programmable gate array (FPGA), complex programmable logic device (CPLD), or fixed-function logic hardware using circuit technologies such as, for example, application specific integrated circuit (ASIC), complementary metal oxide semiconductor (CMOS), or transistor-transistor logic (TTL) technology, and / or combinations thereof.

[0121]

[0167] All definitions defined and used herein should be understood to control for any dictionary definitions, definitions in documents incorporated by reference, and / or ordinary meaning of the defined terms.

[0122]

[0168] The subject matter described herein sometimes depicts different components contained within or connected to different other components. It should be understood that such depicted architectures are merely exemplary, and that in fact many other architectures that achieve the same functionality may be implemented. In a conceptual sense, any arrangement of components to achieve the same functionality is effectively "associated" such that the desired functionality is achieved. Thus, any two components herein that are combined to achieve a particular functionality may be understood to be "associated" with one another such that the desired functionality is achieved, regardless of the architecture or intermediate components. The term "coupled" is used herein to refer to any type of relationship, direct or indirect, between the components in question, and applies to electrical, mechanical, fluid, optical, electromagnetic, electromechanical, or other connections. Similarly, any two components so associated may also be considered to be "operably connected" or "operably coupled" to one another to achieve a desired functionality, and any two components that may be so associated may also be considered to be "operably coupleable" to one another to achieve a desired functionality. Particular examples of operably connectable include, but are not limited to, physically interlocking and / or physically interacting components.

[0123]

[0169] In the claims, as well as in the above specification, the terms "first," "second," and the like are used herein for ease of discussion only and do not carry any particular temporal or chronological significance, unless otherwise indicated.

[0124]

[0170] In the claims, as well as in the above specification, all transitional phrases such as "comprising," "including," "carrying," "having," "containing," "involving," "holding," "comprising," and the like, are to be understood as being open-ended, i.e., intended to include but not limit. Only the transitional phrases "consisting of" and "consisting essentially of" are intended to be closed or semi-closed transitional phrases, respectively.

[0125]

[0171] As used herein, in the specification and in the claims, the singular elements "a," "an," and "the" should be understood to mean "at least one," unless clearly indicated to the contrary.

[0126]

[0172] As used herein, the term "or" or "and / or" is inclusive and not exclusive, unless clearly or otherwise indicated by the context. Thus, herein, "A or B" means "A, B, or both," unless clearly or otherwise indicated by the context. Furthermore, "and" is both jointly and severally, unless clearly or otherwise indicated by the context. Thus, herein, "A and B" means "A and B, jointly or severally," unless clearly or otherwise indicated by the context.

[0127]

[0173] As used herein in the specification and in the claims, the phrase "at least one" in connection with a list of one or more elements should be understood to mean at least one element selected from any one or more of the elements in the list of elements, but not necessarily including at least one of each and every element specifically listed in the list of elements, and not excluding any combination of elements in the list of elements. This provision also allows for elements to be optionally present apart from the elements specifically identified in the list of elements to which "at least one" refers, whether related or unrelated to the specifically identified element.

[0128]

[0174] As used in this application and in the claims, a list of items joined by the term "one or more of" means any combination of the listed terms. For example, the phrase "one or more of A, B, or C" means A; B; C; A and B; A and C; B and C; or A, B and C.

[0129]

[0175] As explained in more detail above, one or more processors, other units, etc., and / or a combination thereof, fulfill the functions of several items recited in the claims.

[0130]

[0176] As explained in more detail above, the computer program may be stored / distributed on a suitable medium, such as an optical storage medium or a solid-state medium, supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless communication systems.

[0131]

[0177] It should also be understood that, unless expressly stated to the contrary, in any method discussed herein that includes multiple steps or acts, the order of the method steps or acts is not necessarily limited to the order in which the method steps or acts are described. Moreover, such methods may have additional or alternative steps or acts.

[0132]

[0178] The mere fact that certain measures are recited in mutually different dependent claims when used in the claims does not indicate that a combination of these measures cannot be used to advantage.

[0133]

[0179] It is further noted that the claims include reference signs / numbers in accordance with PCT Rule 6.2(b), however, the claims should not be considered limited to the exemplary implementations corresponding to those reference signs / numbers.

[0134]

[0180] Those skilled in the art will appreciate from the foregoing description that the broad techniques of the embodiments of the present invention can be implemented in a variety of forms. Thus, although the embodiments of the present invention have been described in connection with specific examples thereof, the true scope of the embodiments of the present invention should not be so limited, as other modifications will become apparent to those skilled in the art upon study of the drawings, specifications, and claims that follow.

Claims

1. a pressure sensor receptor for receiving an arterial blood pressure signal detected by the pressure sensor; an arterial blood pressure monitor communicatively coupled to the pressure sensor receptor; An arterial blood pressure management system comprising: The arterial blood pressure monitor determining whether an arterial blood pressure signal damping event is occurring based on the arterial blood pressure signal; transmitting a command to the electronically controllable valve to control the electronically controllable valve to automatically flush the catheter tubing in response to determining that the arterial blood pressure signal damping event has occurred; determining whether the arterial blood pressure signal dumping event has been resolved in response to automatic flushing of the catheter tubing based on the arterial blood pressure signal, wherein the determination that the arterial blood pressure signal dumping event has occurred is based on a first criterion and the determination that the arterial blood pressure signal dumping event has been resolved is based on a second criterion different from the first criterion; With respect to the first criterion, determining whether the arterial blood pressure signal damping event has occurred based on a pattern change in the arterial blood pressure signal that exceeds one or more specified threshold values ​​within a specified time window; determining whether the arterial blood pressure signal occurring before a specified pre-flash time window exceeds one or more specified flash efficacy threshold values ​​compared to the arterial blood pressure signal occurring after a specified post-flash time window with respect to the second criterion, the one or more specified flash efficacy threshold values ​​including a systolic arterial blood pressure threshold value, a pulse arterial blood pressure threshold value, and an arterial blood pressure waveform slope threshold value; An arterial blood pressure management system.

2. The arterial blood pressure management system of claim 1 , further comprising: the pressure sensor for sensing a patient's arterial blood pressure signal; and the electronically controllable valve for automatically flushing the catheter tubing.

3. A method for operating an arterial blood pressure monitor, comprising: determining whether an arterial blood pressure signal damping event has occurred based on the arterial blood pressure signal detected by the pressure sensor; transmitting a command to the electronically controllable valve to control the electronically controllable valve to automatically flush the catheter tubing in response to determining that the arterial blood pressure signal damping event has occurred; determining whether the arterial blood pressure signal damping event has been resolved in response to automatic flushing of the catheter tubing based on the arterial blood pressure signal, wherein the determination that the arterial blood pressure signal damping event has occurred is based on a first criterion and the determination that the arterial blood pressure signal damping event has been resolved is based on a second criterion different from the first criterion; With respect to the first criterion, determining whether the arterial blood pressure signal damping event has occurred based on a pattern change in the arterial blood pressure signal that exceeds one or more specified threshold values ​​within a specified time window; determining, with respect to the second criterion, whether the arterial blood pressure signal occurring before a specified pre-flash time window exceeds one or more specified flash efficacy threshold values ​​compared to the arterial blood pressure signal occurring after a specified post-flash time window, wherein the one or more specified flash efficacy threshold values ​​include a systolic arterial blood pressure threshold value, a pulse arterial blood pressure threshold value, and an arterial blood pressure waveform slope threshold value; 10. A method of operating an arterial blood pressure monitor, comprising:

4. performing pulse detection to generate the arterial blood pressure signal; extracting pulse features from the arterial blood pressure signal; 4. The method of claim 3, further comprising determining a signal quality for each pulse and associated heartbeat.

5. 5. The method of claim 4, wherein the pulse features are extracted for each beat associated with each pulse, the pulse features including one or more of a pulse interval between beats, an instantaneous arterial blood pressure value, an averaged arterial blood pressure value, an instantaneous maximum arterial blood pressure slope, and an averaged maximum arterial blood pressure slope.

6. Determining whether the arterial blood pressure signal damping event has occurred further comprises: determining whether there is a successive beat-to-beat decrease in systolic arterial blood pressure based on a first threshold value of the one or more specified threshold values; determining whether there is a successive beat-to-beat decrease in the difference between the systolic arterial blood pressure and the diastolic arterial blood pressure based on a second threshold value of the one or more specified threshold values; determining whether the mean arterial blood pressure is stable over time based on a third threshold value of the one or more specified threshold values; determining whether the diastolic arterial blood pressure is stable over time based on a fourth threshold value of the one or more specified threshold values; determining whether a percentage of pulses within the specified time window having a signal quality that exceeds a signal quality threshold value exceeds a fifth threshold value of the one or more specified threshold values; The method of claim 3, based on one or more of:

7. 4. The method of claim 3, further comprising the step of forwarding a dumping event notification to a user interface associated with a medical provider in response to the determination that the arterial blood pressure signal dumping event is occurring, and wherein a blood pressure limit alarm is inhibited in response to forwarding the dumping event notification to the user interface.

8. 4. The method of claim 3, further comprising the step of forwarding an unresolved flash notification to a user interface associated with a treatment provider in response to determining that the arterial blood pressure signal damping event has not been resolved, and wherein a blood pressure limit alarm is inhibited in response to forwarding the unresolved flash notification to the user interface.

9. The method of claim 3 , wherein the method is performed via one or more of a server, a smart hub, a smart cable, an arterial blood pressure monitor, a therapeutic device, and a medical management device.

10. A machine-readable storage containing machine-readable instructions which, when executed, implement the system of claim 1 or 2 or perform the method of any one of claims 3 to 8.

11. Apparatus comprising means for carrying out the method of any one of claims 3 to 8.

Images